Archives for April 2011

I am an active family caregiver; both of my parents are over 80 years of age, and each has a number of significant health issues. Earlier this year, several of my father’s health problems forced him to the emergency room of the Cleveland Clinic and then to hospital stays at that facility. Though it seemed to be touch-and-go for awhile, thankfully he came through it all successfully. During this time of trauma, I again learned something new that is particularly impactful for seniors. During his emergency room stays my father experienced a phenomena that I learned was called ICU (Intensive Care Unit) Psychosis.

WHAT IS ICU PSYCHOSIS— From MedicineNet.com, ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar hospital setting may experience anxiety, become paranoid, hear voices, see things that are not there, become severely disoriented in time and place, become very agitated, even violent, etc… The condition has been formally defined as “acute brain syndrome involving impaired intellectual functioning which occurs in patients who are being treated within a critical care unit.” ICU psychosis is a form of delirium, or acute brain failure. Organic factors including dehydration, hypoxia (low blood oxygen), heart failure (inadequate cardiac output), infection and drugs can cause or contribute to delirium.

Treatment of ICU psychosis depends on the cause; specific treatments apply to each of the respective causes. My father experienced ICU psychosis on more than one occasion. What I found interesting was the vagueness in response I received to my questions regarding how to prevent ICU psychosis.

PREVENTION OF ICU PSYCHOSIS — My research into ICU psychosis indicates that prevention is a work in process. Many critical care units now have instituted visiting hours, they try to minimize shift changes in the nursing staff caring for a patient, the lighting is coordinated with the normal day-night cycle, etc. ICU psychosis usually goes away when the patient leaves the ICU.

One patient in every 3 who spends more than 5 days in an ICU experiences some form of psychotic reaction, according to current estimates. As the number of intensive care units and the number of people in them grow, ICU psychosis is increasing as a problem.

As I stated above, what causes ICU psychosis is not fully known. Something about the ICU causes some people, who are already experiencing great debility, stress and pain, to “lose their minds.” Among the factors which are believed to play into ICU psychosis are:

Sensory deprivation (being put in a room often without windows, away from family, friends and all that is familiar),

Sensory overload (being tethered to noisy machines day and night),

Pain (which may not be adequately controlled in an ICU),

Sleep deprivation,

Disruption of the normal day-night rhythm, or simply

The loss of control over their lives that patients often feel in an ICU.

ICU psychosis often goes away with the coming of morning or sleep. Although it may linger through the day, severe agitation usually occurs only at night. (This phenomenon, called sun-downing, is common in nursing homes).

Although ICU psychosis can occur with any patient in ICU, it is particularly prevalent with seniors. As a loving son and caregiver, ICU psychosis was extremely freighting to observe in my father. Should your senior find him/her self in intensive care, be aware of ICU psychosis, its symptoms and what you might try or suggest to prevent this from occurring to your loved one.